<script src="vendor/minitauros/odf/js/odf.js"></script> <link rel="stylesheet" href="public/css/admin/admin.css"> <div style="padding:10px;"> <div class="card"> <div class="card-block"> <div class="row"> <div class="alert alert-info" role="alert"> <p>Fill out your contact details and receive price quotes in your Inbox.</p> </div> </div> </div> <div class="card-block"> <div class="row"> <div> <form action="xa/products/buy" method="post" class="large odf_ajax"> <input type="hidden" name="combo_id" value="7511"> <input type="hidden" name="product_id" value="3532"> <input type="hidden" name="product_title_text" value="E.Z.N.A.® BAC/PAC DNA-kits (Omega Bio Tek)"> <table class="key_value"> <tbody> <tr class=""> <th> <label for="4RAGa2lIT17438016299698">Product</label> </th> <td > <span >E.Z.N.A.® BAC/PAC DNA-kits (Omega Bio Tek)</span> </td> </tr> <tr class=""> <th> <label for="SE7tIDI174380162997">Your name</label> <span class="required_input">*</span> </th> <td > <input type="text" name="name" value="" placeholder="Your name"> </td> </tr> <tr class=""> <th> <label for="OdBNhsYGoZ17438016299701">Your E-mail</label> <span class="required_input">*</span> </th> <td > <input type="text" name="email" value="" placeholder="Your E-mail"> </td> </tr> <tr class=""> <th> <label for="moh8u78Sa17438016299702">Your phone number</label> </th> <td > <input type="text" name="phone" value="" placeholder="Your phone number"> </td> </tr> <tr> <th></th> <td><button type="submit" class="btn btn-success btn-large">Submit</button></td> </tr> </tbody> </table> </form> </div> </div> </div> </div> </div>